{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:24:57Z","timestamp":1790839497996,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,5,30]],"date-time":"2018-05-30T00:00:00Z","timestamp":1527638400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,5,30]],"date-time":"2018-05-30T00:00:00Z","timestamp":1527638400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Soft tissue balancing is of central importance to outcome following total knee arthroplasty (TKA). However, there are lack of data analysing the effect of tibial bone cut thickness on valgus laxity. A cadaveric study was undertaken to assess the biomechanical consequences of tibial resection depth on through range knee joint valgus stability. We aimed to establish a maximum tibial resection depth, beyond which medial collateral ligament balancing becomes challenging, and a constrained implant should be considered.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eleven cadaveric specimens were included for analysis. The biomechanical effects of increasing tibial resection were studied, with bone cuts made at 6, 10, 14, 18 and 24\u00a0mm from the lateral tibial articular surface. A computer navigation system was used to perform the tibial resection and to measure the valgus laxity resulting from a torque of 10\u00a0Nm. Measurements were taken in four knee positions: 0\u00b0 or extension, 30\u00b0, 60\u00b0 and 90\u00b0 of flexion. Intra\u2010observer reliability was assessed. A minimum sample size of eight cadavers was necessary. Statistical analysis was performed using a nonparametric Spearman\u2019s ranking correlation matrix at the different stages: in extension, at 30\u00b0, 60\u00b0 and 90\u00b0 of knee flexion. Significance was set at <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was no macroscopic injury to the dMCL or sMCL in any of the specimens during tibial resection. There was no significant correlation found between the degree of valgus laxity and the thickness of the tibial cut with the knee in extension. There was a statistically significant correlation between valgus laxity and the thickness of the tibial cut in all other knee flexion positions: 30\u00b0 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001), 60\u00b0 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and 90\u00b0 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). We identified greater than 5\u00b0 of valgus laxity, at 90\u00b0 of knee flexion, after a tibial resection of 14\u00a0mm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Increased tibial resection depth is associated with significantly greater valgus laxity when tested in positions from 30\u00b0 to 90\u00b0 of flexion, despite stability in extension. Greater than 5\u00b0 of laxity was identified with a tibial resection of 14\u00a0mm. When a tibial bone cut of 14\u00a0mm or greater is necessary, as may occur with severe preoperative coronal plane deformity, it is recommended to consider the use of a constrained knee prosthesis.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-018-4988-1","type":"journal-article","created":{"date-parts":[[2018,5,30]],"date-time":"2018-05-30T03:51:08Z","timestamp":1527652268000},"page":"1450-1455","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Increased valgus laxity in flexion with greater tibial resection depth following total knee arthroplasty"],"prefix":"10.1002","volume":"27","author":[{"given":"E.","family":"Sappey\u2010Marinier","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Centre Albert Trillat, Orthopaedic Surgery Croix\u2010Rousse Hospital Lyon 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December 2017","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 May 2018","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 May 2018","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethical approval was obtained from the Rockefeller anatomy laboratory, Grange Blanche, Lyon, France.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}